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Tips on How a Dialysis Facility and Patients Can Prepare for an Emergency
EasyLink Access #: 205
By Svetlana (Lana) Kacherova, RN, MPHHE, BSN, CPHQ
“An emergency stops being one when you are ready for it.” These words are important to reflect upon when you realize that, during the last few years, the United States has experienced several disasters (particularly Hurricane Katrina) that seriously disrupted the lives of many dialysis patients because they could not get to their clinics to receive treatments. Emergencies caused by severe weather (hurricanes, earthquakes, snowstorms, power outages, etc.) can occur suddenly and without warning. Your availability to water, power, transportation, or supplies may be limited. You may not be able to get to your dialysis unit for treatment or give yourself treatments at home. Therefore, the importance of being prepared for such events cannot be overstated. "Preparing for Emergencies" The federally mandated End-Stage Renal Disease (ESRD) Networks have been working closely with the dialysis patient and provider community in an effort to be able to handle such emergencies. An emergency could be of different nature and magnitude. Whether they are expected or sudden, they create a lot of stress and panic. There are plenty of materials developed on emergency preparedness and response. In my opinion, one of the best resources for dialysis patients is the brochure, Preparing for Emergencies: A Guide for People On Dialysis, published by the Centers for Medicare and Medicaid Services (CMS), Publication No. 10150. You can also access it on-line at www.RSNhope.org. Most of the information below is taken directly from this brochure. What Has to Be Done in the Dialysis Clinic?
Following are some of the most important things you need to do to prepare for an in-center emergency: Ask for a copy of the facility disaster plan. Participate in regular fire drills. Know where the facility emergency exits are. Ask your nurse or patient care technicians for a copy of your current treatment information in case you are not able to return to your own home unit for your next few treatments. Learn the “clamp and cut” procedure in the facility on how to disconnect yourself from the machine in case of an emergency. (Details on this very important procedure are included below.) Find out about alternative arrangements for treatment if you are not able to go to your facility. It is a Federal law that every facility has a back-up facility and that the patient is aware of it. Gather and carry important medical information. This includes your medical history with known allergies and type of dialysis you receive along with the current dialysis orders and medication list, and a copy of your medical insurance card. Keep emergency telephone numbers and addresses handy. These should include your own home and cell phone numbers and street address, dialysis unit, doctor, relatives and friends (preferably, one friend or relative should be out-of-state). Obtain a medical emblem identifying yourself as a dialysis patient so others will be able to know your needs in case you are injured and not able to communicate. Obtain a copy of the CMS booklet Preparing for Emergencies: A Guide for People on Dialysis. I would suggest you ask for two copies and keep one of them in your emergency supply kit at home.
"Clamp and Cut"
If they have not done so, ask your dialysis facility staff to show you what to do if you are on your dialysis machine when an emergency or disaster strikes. Their instructions should include the location of your emergency pack and how to safely disconnect yourself from the machine. At a minimum, the emergency pack should include scissors, tape, clamps, and other necessary medical items. This pack should be kept within your reach while you are having your treatment. If you are connected to your dialysis machine when the emergency occurs, remain calm and wait or ask for instructions from your dialysis staff. If no one on the staff is available, you may have to learn how "clamp and disconnect" yourself. It is very important to remember that the following directions are for emergency evacuations only. Leave your vascular access needles in place until you can get to a safe location. NEVER cut your access needle lines.
The Clamp and Disconnect Procedure Follow these directions only if no qualified dialysis personnel are available to disconnect you from your machine: Clamp both your access needles. Clamp both of the thicker bloodlines. If these lines have pinch clamps, pinch all four of the clamps closed. Unscrew or cut the lines between the closed clamps. If it is necessary to cut your lines, cut only the thicker bloodlines. NEVER, NEVER cut your access needle lines. NEVER cut the line between the clamp and your access because you will probably quickly bleed to death.
Taking Care of Your Access During an Emergency
Once you have been disconnected from your dialysis machine, immediately go to your designated safe area and wait for instructions from the person in charge. This person may be a paramedic, police officer, firefighter, doctor, nurse, or dialysis facility staff member. Do not remove your fistula needles until you have been checked by medical personnel. And never allow any medical or other personnel unfamiliar with your dialysis status to place or inject anything into your vascular access. What Has to Be Done at Home? - A general rule is that all critical services are restored within 72 hours after a disaster. This means
that you have to be able to survive on your own for at least that long–and you can do it! Refer to the
brochure for the three-day emergency survival diet or ask your dietitian. (See the 72 Hours website
address below.) - Keep emergency medication supplies at home and check them regularly for the expiration dates. That would normally include a 5-7 day supply of all medicines, including antibiotics and diuretics (fluid pills), as well as Sorbitol, and Kayexalate for potassium control (if recommended by a doctor). If you are diabetic, you should have a 5-7 day supply of syringes, insulin, and blood sugar monitoring supplies. Try to go over your emergency kit twice a year and replace any outdated medications or other items.
- Keep an emergency box at home with everything you might need. This includes such items as renal-friendly food, radio and batteries, can opener, first aid kit, water jugs, etc. Remember that food and water supplies should last for at least three days.
- Prepare your family to handle emergencies. Everyone in your household will cope a lot better if you have a plan. Contact your local Office of Emergency Services to find out about the emergency plan for your community.
What to Do If You Are Traveling Make the necessary arrangements for obtaining dialysis at a unit near your destination.
Have any necessary equipment or supplies delivered ahead of time.
Carry a fanny pack that includes medications, a list of emergency numbers, important medical information, diabetic and other supplies as necessary. Including an extra pair of eyeglasses is always a good idea.
Conclusion Following are some resources that may be of help to you as a dialysis patient facing an emergency or disaster situation: Medicare coverage. Call (800) 633-4227.
Dialysis facilities. Log onto: www.medicare.gov and select "Dialysis Facility Compare" for information on dialysis units around the country.
State Survey Agency. Call the toll-free Medicare number (800-633-4227) for the phone number in your state. The State Survey Agencies oversee dialysis facilities to ensure that they meet Medicare standards.
ESRD Networks. Log onto the Forum of ESRD Networks at: www.esrdnetworks.org for information about one of the 18 networks that covers the area where you live. Your network can provide you with the locations of dialysis facilities and transplant centers and give you advice on getting the best possible care
In conclusion, remember that you are a person with special needs, and you are the one responsible for your own survival. The better you are prepared, the less stressful it will be for you and your family. Remember: An emergency stops being one when you are ready for it. About the Author
Svetlana (Lana) Kacherova, RN, MPHHE, BSN, CPHQ, is a Quality Improvement Director for ESRD Network 18 (the Southern California Renal Disease Council, Inc.) that oversees all hemodialysis facilites and kidney transplant centers in Southern California comprising about 28,000 patients. Her primary job responsibility is to ensure that Medicare beneficiaries are receiving quality care. Lana has been working in hemodialysis facilities throughout Southern California since 1993.
Last Updated June 2007
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